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  • 201.
    Edin-Liljegren, Anette
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Daerga, Laila
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Reindeer-herding Sami experiences of seeking care in the mainstream society2016In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, no 33200Article in journal (Refereed)
  • 202.
    Edvardsson, Berit
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Bergdahl, Jan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Eriksson, Nils
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Linden, G
    Widman, L
    The medical and social prognosis of Sick Building Syndrome: a follow-up study focusing on female patients2005In: Indoor air 2005: proceedings of the 10th international conference on indoor air quality and climate, vols 1-5 / [ed] Yang, X; Zhao, B; Zhao, R, Beijing: Tsinghua university press , 2005, p. 3706-3710Conference paper (Refereed)
    Abstract [en]

    A follow-up questionnaire focusing medical and social status, actions taken and personality traits was sent to 239 patients with Sick Building Syndrome (SBS) registered at the University Hospital in Umea, Sweden. The response rate was 79 percent. As females constituted 92 percent of the respondents all statistical analyses were restricted to women. Almost half of the respondents had been exposed to environments with visible water damages. Fatigue, irritated eyes and facial erythema were the most common symptoms. Nearly half of the patients claimed that the symptoms were more or less unchanged after 7 years or more. Twenty-five percent of the patients were on the sick-list and twenty percent drew disability pension due to SBS-symptoms at follow-up. Symptoms were often aggravated in different situations in everyday life. No important deviations concerning personality factors were found. The results support that early and comprehensive measures for rehabilitation are essential for these patients.

  • 203.
    Egberg Thyme, Karin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    What do you see?: studies on time-limited psychodynamic art psychotherapy2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main purpose of this thesis is to explore experiences of two different psychological interventions based on art psychotherapy in women with a psychological or physical illness. The two interventions are art psychotherapy and art therapy. The difference between these two interventions is that the art therapist works with the transference in art psychotherapy but not in art therapy. The thesis consists of two studies of art psychotherapy: An art psychotherapy intervention is evaluated in Study 1 (papers III and V) which examines a group of patients diagnosed with depression and Study 2 (paper II) which examines experiences in a group of six patients diagnosed with vulva vestibulitis. An art therapy intervention is evaluated in the third study (papers I and IV); where experiences in patients diagnosed with breast cancer are examined.

    In Study 1, forty-three (n=43) depressed women were randomly assigned to either an intervention group or a control group (verbal psychotherapy). The aim was to examine the outcome of time limited psychodynamic art therapy compared to time-limited psychodynamic verbal therapy for patients with depressive symptoms. Interviews were performed before, immediately after, and three months after the termination of psychotherapy, and self-rating scales which focus on stress reactions, depression and symptoms as well as an observer rating scale on depression were used. The interviews and the art sessions were video-recorded, and the verbal psychotherapy was tape-recorded. The results showed that the art and verbal psychotherapies were comparable. The conclusion was that short-term psychodynamic art psychotherapy could be a valuable treatment for depressed women. In an in-depth content analysis, the method of scribbling was further investigated and exemplified with the therapies of two participants. In this study, the patients’ pictures and verbal expressions of progress, along with considerations of how to interpret the pictures were in focus. When leaving therapy the two patients took advantage of the paper, made complete forms, symbolised in words what they have expressed in pictures; in pace with psychotherapy the themes alter towards separation, individuation, and attempt to relate in a new way. The conclusion was that limelimited psychodynamic art therapy suggests giving a safer place for the self as the cohesion is firmer with better boundaries.

    Study 2 is a pilot study, which involved six young patients newly diagnosed with vulva vestibulitis. The aim of the study was to investigate pain at vestibulum, mental health, and self-image after fifteen sessions of art psychotherapy. Five of the patients were judged to have less pain three months after termination of therapy. The conclusion was that art psychotherapy with its openness seemed to affect young women in their experiences of vulva vestibulitis in a positive direction.

    Study 3 examined the potential benefit of art therapy for women with primary breast cancer. The sample comprised forty-one (n=41) patients who were randomly assigned either to an art therapy group or to a control group. The art therapy was going on during five weeks radiation treatment, one session per week. The aim was to investigate the outcome of art therapy, to quantify and compare the participant coping s, self-image, and the symptoms with the participant in the control group. Interviews were performed before, immediately after, and six month after inclusion. A set of self-rating scales was used: Coping Resources Inventory, the Structural Analysis of Social Behavior, and Symptom Check List – 90. The result showed that the patients in the art therapy group rated their coping s and especially their social s, higher than the control group, and that the average patients in the art therapy group improved in depressive symptoms and symptoms of anxiety, and that the general psychiatric symptoms improved as well. A linear regression analysis showed a tendency that the coping s increased in the art therapy group and decreased in the control group or even stagnated in the social domain. A second report on self-image, symptoms, treatment, and social variables showed that art therapy was related to lower ratings of depression, anxiety, and general symptoms after treatment; chemotherapeutic treatment predicted lower depressive symptoms and general symptoms in contrast to axilliary surgery and hormonal treatment. The results showed that art therapy could be valuable complementary therapy in routine oncology practise. The conclusion is that art therapy can have a positive long-term effect on the crisis following the primary breast cancer and its consequences.

    Conclusion: The results show that time-limited psychodynamic art psychotherapy is valuable for depressed women; that it is a valuable complement for women with vulva vestibulitis; and that art therapy is a valuable complement in the care and cure of women with primary breast cancer.

  • 204.
    Egberg Thyme, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundin, Eva C
    Division of Psychology, Nottingham Trent University, Nottingham NG1 4BU, England.
    Ståhlberg, Gustaf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Lindström, Birgit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Eklöf, Hanna
    Umeå University, Faculty of Social Sciences, Department of Educational Measurement.
    Wiberg, Britt
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    The outcome of short-term psychodynamic art therapy compared to short-term psychodynamic verbal therapy for depressed women2007In: Psychanalytic Psychotherapy, ISSN 0266-8734, Vol. 21, no 3, p. 250-264Article in journal (Refereed)
    Abstract [en]

    The primary aim of this randomized controlled clinical trial was to compare the outcome from two types of short-term psychodynamic psychotherapy. The participants were thirty-nine women with depression. Half of the participants (n = 18) received art psychotherapy and the other half received verbal psychotherapy (n = 21). Data was collected before and after psychotherapy, and at a 3-month follow-up using self-rating scales and interviewer-based ratings. Results showed that art and verbal psychotherapies were comparable, and at follow-up, the average participant in both groups had few depressive symptoms and stress-related symptoms. The conclusion was that short-term psychodynamic art therapy could be a valuable treatment for depressed women.

  • 205.
    Egberg Thyme, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundin, Eva C.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Wiberg, Britt
    Division of Psychology, Nottingham Trent University, Nottinham, United Kingdom.
    Öster, Inger
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Individual brief art therapy can be helpful for women with breast cancer: A randomized controlled clinical study2009In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 7, no 1, p. 87-95Article in journal (Refereed)
    Abstract [en]

    Objective: Recent research shows that almost every second woman with breast cancer is depressed or has anxiety; the risk for younger women is even higher. Moreover, research shows that women are at risk for developing depression, also a threat for women with breast cancer. The aim of this randomized controlled clinical trial was to study the outcome of five sessions of art therapy given at a 5-week period of postoperative radiotherapy.

    Methods: The participants were between 37 and 69 years old; six participants in each group were below 50 years of age. Half of the participants (n = 20) received art therapy and the other half (n = 21) were assigned to a control group. At the first measurement, at least 17% (n = 7) of the participants medicated with antidepressants. Data were collected before and after art therapy and at a 4-month follow-up using self-rating scales that measure self-image (the Structural Analysis of Social Behaviour) and psychiatric symptoms (the Symptom Check List–90).

    Results: At follow-up, significant lower ratings of depression, anxiety, and somatic symptoms and less general symptoms were reported for the art therapy group compared to the control group. The regression analysis showed that art therapy relates to lower ratings of depression, anxiety, and general symptoms; chemotherapeutic treatment predicts lower depressive symptoms; in contrast to axilliary surgery and hormonal treatment as well as being a parent predicts higher ratings of anxiety and general symptoms.

    Significance of results: The conclusion suggests that art therapy has a long-term effect on the crisis following the breast cancer and its consequences.

  • 206.
    Egberg Thyme, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundin, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lindström, Birgit
    Wiberg, Britt
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Larsson, Nils
    Sjöberg, Inga
    Wikman, Marianne
    Förändringar av vestibulitsmärtor, psykiskt mående och välbefinnande samt upplevelser av själv och andra: en systematisk pilotstudie av sex unga kvinnor med vulva vestibulit som genomgått tidsbegränsad bildpsykoterapi2007In: Matrix, ISSN 0109-646x, Vol. 24, no 1, p. 49-72Article in journal (Refereed)
  • 207.
    Eisemann, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychosocial aspects of depressive disorders1985Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The objective of this study was to elucidate the possible importance of factors from the social environment for the development of depression. As a theoretical framework, Engel's biopsychosocial model (Engel, 1980), based on systems theory, has been applied. Proceeding from the single individual (characterized by experience, personality, behaviour) as the highest level of the organismic hierarchy the following system levels have been taken into account: dyads, family, community, culture-subculture.

    The depressive patients (n=lll) showed to be living in a narrowed social network and to lack confiding relationships compared with a non-psychiatric control sample (n=98). The personality characteristics (e.g. anxiety, detachment, suspicion) of the patients were related to experienced loneliness, contact difficulties, social network features and leisure activities. By means of a discriminant analysis 83% of the subjects could be correctly classified. In a study of perceived parental rearing, depressives showed to have experienced lack of emotional warmth. As regards social class an overrepresentation of social class III in the subgroups of unipolar, bipolar and unspecified depression was observed.

    Finally, implications for treatment are discussed in favour of a combination of drug and cognitive psychotherapy. Future research strategies are also suggested.

  • 208.
    Eisemann, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lalos, Ann
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Psychosocial determinants of well-being in gynecologic cancer patients1999In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 22, no 4, p. 303-306Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the well-being of women with endometrial versus cervical cancer before treatment, and its determinants at 12 to 15 months follow-up. The subjects were interviewed before treatment, then 6 and 12 to 15 months after initiation of treatment. Simultaneously, they completed questionnaires on psychological symptoms and social support. It appeared that well-being at baseline and at the follow-ups were highly correlated. Furthermore, cervical cancer patients reported significantly more symptoms on all occasions. After discriminant function analysis, the following three variables remained in the analysis: (a) well-being before treatment, (b) diagnosis, and (c) children at home. This allowed 81% of the patients to be classified as having a favorable versus an unfavorable outcome. The results of this study highlight the importance of well-being before treatment as a predictor of well-being after treatment. The necessity of individualized intervention measures is warranted.

  • 209.
    Ejelöv, Marina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bergström, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Mattsson, Monica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    “Many obstacles along the way”: follow-up of rehabilitation plans after multimodal pain rehabilitation2016In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 18, no 1, p. 18-26Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the content of rehabilitation plans after multimodal rehabilitation (MMR) for chronic pain patients, focusing on occupation-oriented measures. A secondary aim was to study how the individual rehabilitation plans had been carried out and implemented during 1 year after MMR. A multiple methods approach with quantitative and qualitative data was used. The quantitative part was descriptive and examined whether the rehabilitation plans were carried out, the number of recommendations in each plan and the type of measures suggested. The qualitative part constituted a content analysis of interviews. Vocational rehabilitation was the second most common recommendation for the whole group. The analysis of the interviews resulted in seven categories divided into two main categories: impeding factors and facilitating factors for rehabilitation. The compliance of professionals and external parties with the patients’ rehabilitation plans, and the patients’ positive experience of their change in behaviour, contributed to the completion of the rehabilitation plans. In conclusion, lack of follow-up from the professionals and negative bodily signals inhibited the completion of rehabilitation. Flexibility on the part of professionals and external actors regarding patients’ rehabilitation plans as well as their own positive experiences of striving for change facilitated rehabilitation.

  • 210.
    Ekholm, Birgit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Diagnostic Evaluation of Schizophrenia for Genetic Studies2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Schizophrenia is one of the most severe mental disorders. Heredity is accepted as a major causative factor. To find molecular mechanisms behind schizophrenia, patient materials with reliable and valid diagnoses must be identified. In order to compare schizophrenia diagnostic procedures for reliability, validity and suitability for genetic studies by evaluation of record information, interview and register diagnostic data and to examine patient materials for linkage or association with molecular genetic markers three patient materials were recruited: sporadic cases, a large pedigree and sib-pairs.

    Schizophrenia diagnoses based on patient records only, showed good to excellent agreement with diagnoses based on both records and interviews. Register diagnoses generally displayed poor agreement with research diagnoses, but in 94% of patients sometimes registered as schizophrenic psychoses a research diagnosis of these disorders was certified. In the pedigree, analysis suggested linkage to chr 6p23 in a single branch of the pedigree, and a genome scan indicated linkage to the 6q25 region. A genome scan analysis of the sib-pair material was suggestive of linkage to chr 10q25.3-q26.3. In the case-control sample and a meta-analysis there was an association between a dopamine D2 receptor polymorphism (Ser311Cys), on chr 11q22-23, and the disorder. Brain-derived neurotrophic factor gene variants (chr 11p13) were also analysed without any robust significant findings.

    For patients in long-term treatment for schizophrenia in Sweden, psychiatric record reviews should be valid, reliable and sufficient for assessment of lifetime research diagnosis. Swedish register diagnosis of schizophrenic psychoses has a high positive predictive power in relation to corresponding research diagnoses. For future Swedish studies focusing on a broad definition of schizophrenia, it is sufficient to rely on the register diagnoses of schizophrenic psychosis. There is no major vulnerability gene or locus that is common to the majority of patients with schizophrenia, indicating genetic heterogeneity.

  • 211.
    Ekholm, Birgit
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ekholm, Andreas
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Vares, Maria
    Osby, Urban
    Sedvall, Göran C
    Jönsson, Erik G
    Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses.2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 6, p. 457-464Article in journal (Refereed)
    Abstract [en]

    We aimed to estimate the value of structured interviews, medical records and Swedish register diagnoses for assessing lifetime diagnosis of patients with schizophrenia. Psychiatric records and diagnostic interviews of 143 Swedish patients diagnosed by their treating physician with schizophrenia and related disorders were scrutinized. Based on record analysis only, or a combined record and interview analysis, DSM-IV diagnoses were obtained by the OPCRIT algorithm. Independent of the OPCRIT algorithm, a standard research DSM-IV diagnosis, based on both record and interview analysis, was given by the research psychiatrist. Concordance rates for the different psychosis diagnoses were calculated. DSM-IV diagnoses based on records only, showed a good to excellent agreement with diagnoses based on records and interviews. Swedish register diagnoses displayed generally poor agreement with the research diagnoses. Nevertheless, 94% of subjects sometimes registered with a diagnosis of schizophrenic psychoses (i.e. schizophrenia, schizoaffective psychosis or schizophreniform disorder) displayed a standard research DSM-IV diagnosis of these disorders. For patients in long-term treatment for schizophrenia in Sweden, psychiatric record reviews should be optimal, cost effective and sufficient for assessment of lifetime research diagnoses of schizophrenia. For these patients a research interview adds little new information. The results further indicate that a Swedish register diagnosis of schizophrenic psychoses has a high positive predictive power to a standard research DSM-IV diagnosis of the disorders. It is concluded that for future Swedish large-scale genetic studies focusing on a broad definition of schizophrenia, it would be sufficient to rely on the Swedish register diagnoses of schizophrenic psychosis.

  • 212.
    Eklund, Mona
    et al.
    Lund, Sweden.
    Gunnarsson, A. Birgitta
    Lund, Sweden; Unit for Research and Development, Kronoberg County Council, Växjö, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Leufstadius, Christel
    Lund, Sweden.
    Effectiveness of an intervention to improve day centre services for people with psychiatric disabilities2014In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 61, no 4, p. 268-275Article in journal (Refereed)
    Abstract [en]

    Background/aim: Day centres for people with psychiatric disabilities need to be evaluated for effectiveness in order to provide the best possible support. This study aimed at investigating the effectiveness of a tailor-made intervention to improve day centre services for people with psychiatric disabilities.

    Methods: The intervention was devised to bridge identified gaps in the services and lasted for 14 months. Eight centres were allotted to the intervention (55 attendees) or comparison condition (51 attendees). Fidelity to the intervention and major events in the day centres were assessed. The outcomes were degree of meaningfulness found in the day centre occupations, satisfaction with the rehabilitation received, satisfaction with everyday occupations and quality of life.

    Results: The fidelity to the intervention was good, but more positive events, such as new occupational opportunities, had taken place in the comparison units. No differences were identified between the intervention and the comparison group regarding changes from baseline to the 14-month follow-up in perceived meaningfulness among day centre occupations, satisfaction with everyday occupations or quality of life.

    Conclusions: The intervention seemed ineffective, but the positive events in the comparison group resembled the measures included in the tailor-made interventions. This first intervention study in the day centre context has hopefully helped to generate hypotheses and methods for future research.

  • 213. Eklund, Mona
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Predictors of valued everyday occupations, empowerment and satisfaction in day centres: implications for services for persons with psychiatric disabilities2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 582-590Article in journal (Refereed)
    Abstract [en]

    This study addresses predictors of occupational value, empowerment and satisfaction with the rehabilitation received in day centres for people with psychiatric disabilities. These outcomes represent varying aspects of relevance for the day centre context and together create a manifold outcome picture. This was a longitudinal study with approval from the regional research vetting board. Self-report instruments were used, and the investigated predictors motivation for going to the day centre, occupational engagement, socio-demographic factors and self-reported diagnosis. Attendees (N = 108) at 8 day centres participated and filled in self-report questionnaires regarding the predictor and outcome variables. A baseline measurement and a 14-month follow-up composed the data. Occupational engagement at baseline could predict all three outcomes at the follow-up. Motivation for the day centre activities and not preferring work before attending the day centre were positive for satisfaction with the day centre. A low participation rate, although comparable with previous studies on the target group, was a limitation of this study. To conclude, both occupational engagement and motivation are factors that can be stimulated by the staff in day centres. Actions for how to accomplish that, and thereby also more positive outcomes of the day centre services, are proposed, such as a system of freedom of choice among day centres, and between day centres and supported employment.

  • 214. Eklund, Mona
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The life situation of people with persistent mental illness visiting day centers: a comparative study2012In: Community mental health journal, ISSN 0010-3853, E-ISSN 1573-2789, Vol. 48, no 5, p. 592-597Article in journal (Refereed)
    Abstract [en]

    This study compared the life situation of visitors of day centers (DC) for people with mental illness (N = 93) with a comparison group (N = 82) in respect of sociodemographic and clinical characteristics, care consumption, well-being and everyday activities. The response rate was 49%, and those who declined are believed to be those with the most severe psychiatric disabilities. Most individuals were single (81%/78%) and few had children (12%/18%). The DC group had less education than the comparison group but had a friend more often. Although having their need for daily activities met, the DC group had greater unmet needs in respect of daily living in general. They less frequently reported having a psychosis and had fewer negative and more depressive symptoms. They got more housing support and general outpatient care, while the comparison group used specialized psychiatric care more frequently. The samples were equally satisfied with their care, health and well-being and found their everyday activities equally meaningful. The DC visitors formed a vulnerable group, by living single, having a low level of education and having unmet needs, and were at risk of not getting specialized psychiatric care.

  • 215. Eklund, Mona
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Work experiences among attendees of day centres for people with psychiatric disabilities2016In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 53, no 2, p. 377-385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is possible that people with psychiatric disabilities who visit day centres have previous work experiences that may be seen as resources for their current engagement in day centre activities. Research in this respect seems to lack, however.

    OBJECTIVE: To investigate work experiences among attendees at day centres for people with psychiatric disabilities and relationships with current type of day centre (work-oriented, meeting place-oriented or mixed), engagement in day centre activities, motivation and socio-demographic and health-related factors.

    METHODS: Seventy-seven attendees responded to questionnaires. Global Assessment of Functioning, GAF, was also used. Work was categorised into Group I (professionals, semi-professionals), Group II (clerical support, services workers) and Group III (e.g. craft workers, elementary occupations).

    RESULTS: Almost everyone had previously had open-market employment; more than half for ≥10 years. Group I was more common in mixed centres, Group II in meeting place-oriented ones and Group III in work-oriented ones. Group I more frequently had college degree and was rated high on GAF functioning. Women were over-represented in Group II, and men in Group III and in meeting place-oriented centres. Attending mixed centres was more likely when having a college degree, scoring high on GAF functioning and being highly engaged in activities. Attendees at work-oriented day centres were characterised by being motivated for spending time alone and reporting a diagnosis of psychosis.

    CONCLUSIONS: The participants had unused working capacity. No clear-cut relationships were found between work experiences and the investigated correlates.

  • 216. Eklund, Mona
    et al.
    Tjörnstrand, Carina
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Argentzell, Elisabeth
    Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness - a cluster RCT study2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 363Article in journal (Refereed)
    Abstract [en]

    Background: Many with a mental illness have an impoverished everyday life with few meaningful activities and a sedentary lifestyle. The study aim was to evaluate the effectiveness of the 16-week Balancing Everyday Life (BEL) program, compared to care as usual (CAU), for people with mental illness in specialized and community-based psychiatric services. The main outcomes concerned different aspects of subjectively evaluated everyday activities, in terms of the engagement and satisfaction they bring, balance among activities, and activity level. Secondary outcomes pertained to various facets of well-being and functioning. It was hypothesized that those who received the BEL intervention would improve more than the comparison group regarding activity, well-being and functioning outcomes.

    Methods: BEL is a group and activity-based lifestyle intervention. CAU entailed active support, mainly standard occupational therapy. The BEL group included 133 participants and the CAU group 93. They completed self-report questionnaires targeting activity and well-being on three occasions – at baseline, after completed intervention (at 16 weeks) and at a six-month follow-up. A research assistant rated the participants’ level of functioning and symptom severity on the same occasions. Non-parametric statistics were used since these instruments produced ordinal data.

    Results: The BEL group improved more than the CAU group from baseline to 16 weeks on primary outcomes in terms of activity engagement (p < 0.001), activity level (p = 0.036) and activity balance (p < 0.042). The BEL group also improved more on the secondary outcomes of symptom severity (p < 0.018) and level of functioning (p < 0.046) from baseline to 16 weeks, but not on well-being. High intra-class correlations (0.12–0.22) indicated clustering effects for symptom severity and level of functioning. The group differences on activity engagement (p = 0.001) and activity level (p = 0.007) remained at the follow-up. The BEL group also improved their well-being (quality of life) more than the CAU group from baseline to the follow-up (p = 0.049). No differences were found at that time for activity balance, level of functioning and symptom severity.

    Conclusion: The BEL program was effective compared to CAU in terms of activity engagement. Their improvements were not, however, greater concerning other subjective perceptions, such as satisfaction with daily activities and self-rated health, and clustering effects lowered the dependability regarding findings of improvements on symptoms and functioning. Although the CAU group had “caught up” at the follow-up, the BEL group had improved more on general quality of life. BEL appeared to be important in shortening the time required for participants to develop their engagement in activity and in attaining improved quality of life in a follow-up perspective.

  • 217.
    Ekman, Inger
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Söderberg, Stig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Across the street - not down the road - staying alive through deliberate self-harm2009In: Internet and Suicide, New York: Nova Science Publisher , 2009, p. 221-232Chapter in book (Other academic)
    Abstract [en]

    While the psychiatric therapeutic community is focused on individual diagnostic tools to understand deliberate self harm, self-destructive behaviour among young persons in Western society is increasing to a level where it arguably must be regarded as a cultural rather than an individual problem. While psychiatry adheres to its expert role, trying to find explanations for the individual behaviour in past life experiences and subsequent personality formation, the world outside of the therapy room is changing. In this outside world, on the Internet deliberate self harm is not described as a pathological behaviour that needs to be corrected, but as a powerful tool to cope with present life stressors, a way to form an identity and even as a way of staying alive. Against a background of present trends in society and how these influence identity formation, these narratives give important clues for finding new approaches to the experiences and life strategies of young persons living in modern society. In encounters with young persons whose self-harming behaviour has become intimately woven into the fabric of life, the keys to opening up different perspectives and find other ways to cope probably can not be found without accrediting the strength and determination in the present behaviour and closely and attentively pay attention to her own understanding of her situation, her own strengths and her own abilities.

     

  • 218.
    Ekman, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Eriksson, Johan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Domellöf, Magdalena
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Elgh, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundquist, Anders
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Longitudinal changes in task-evoked brain responses in Parkinson's disease patients with and without mild cognitive impairment2014In: Frontiers in Neuroscience, ISSN 1662-4548, E-ISSN 1662-453X, Vol. 8, article id 207Article in journal (Refereed)
    Abstract [en]

    Cognitive deficits are common in Parkinson's disease. Previous cross-sectional research has demonstrated a link between cognitive impairments and fronto-striatal dopaminergic dysmodulation. However, longitudinal studies that link disease progression with altered task-evoked brain activity are lacking. Therefore, our objective was to longitudinally evaluate working-memory related brain activity changes in Parkinson's disease patients with and without mild cognitive impairment (MCI). Patients were recruited within a longitudinal cohort study of incident patients with idiopathic parkinsonism. We longitudinally (at baseline examination and at 12-months follow-up) compared 28 patients with Parkinson's disease without MCI with 11 patients with Parkinson's disease and MCI. Functional MRI blood oxygen level dependent signal was measured during a verbal two-back working-memory task. Patients with MCI under-recruited bilateral medial prefrontal cortex at both time-points (main effect of group: p < 0.001, uncorrected). Critically, a significant group-by-time interaction effect (p < 0.001, uncorrected) was found in the right fusiform gyrus, indicating that working-memory related activity decreased for patients with Parkinson's disease and MCI between baseline and follow-up, while patients without MCI were stable across time-points. The functional connectivity between right fusiform gyrus and bilateral caudate nucleus was stronger for patients without MCI relative to patients with MCI. Our findings support the view that deficits in working-memory updating are related to persistent fronto-striatal under-recruitments in patients with early phase Parkinson's disease and MCI. The longitudinal evolution of MCI in Parkinson's disease translates into additional task-evoked posterior cortical changes.

  • 219. Ekselius, L
    et al.
    Lindström, E
    von Knorring, L
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Personality disorders in DSM-III-R as categorical or dimensional.1993In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 88, no 3, p. 183-7Article in journal (Refereed)
    Abstract [en]

    Despite the atheoretical approach of the DSM-III-R, the personality disorders have their roots in specific theoretical schools. Due to clinical tradition, analogies with Axis I and the tradition in psychiatry and medicine, the personality disorders are presented as categories although there is more empirical support for a dimensional approach. This study attempted to determine whether the separate personality disorders meet Kendell's criteria for distinct entities, i.e., bimodality with distinct points of rarity. None of the personality disorders met the criteria for a distinct disease entity. Instead, all of the personality disorders presented as continuous, dimensional personality traits present among healthy subjects and more pronounced in patients with mental disorders.

  • 220. Ekselius, L
    et al.
    Lindström, E
    von Knorring, L
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R.1994In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 90, no 2, p. 120-3Article in journal (Refereed)
    Abstract [en]

    A modified version of the SCID Screen questionnaire covering 103 criteria by means of 124 questions was compared with SCID II interviews in 69 psychiatric patients. The correlation between the number of criteria fulfilled in the SCID II interviews or the questionnaires was 0.84. In the SCID interviews, 54% of the patients had a personality disorder. When the SCID Screen questionnaire was used, 73% had a personality disorder. When the cut-off level for diagnosis was adjusted, the frequency found by means of the SCID screen questionnaire or the interviews was roughly the same, 58% and 54%, respectively. The overall kappa for agreement between the SCID II interviews and questionnaire with adjusted cut-off was 0.78.

  • 221. Ekström, Ingrid
    et al.
    Sjölund, Sara
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin Adolfsson, Annelie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nilsson, Lars-Göran
    Larsson, Maria
    Olofsson, Jonas K.
    Smell Loss Predicts Mortality Risk Regardless of Dementia Conversion2017In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 65, no 6, p. 1238-1243Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine whether dementia could explain the association between poor olfactory performance and mortality risk within a decade-long follow-up period. Design: Prospective cohort study. SettingBetula Study, Umea, Sweden. ParticipantsA population-based sample of adult participants without dementia at baseline aged 40 to 90 (N = 1,774). Measurements: Olfactory performance using the Scandinavian Odor-Identification Test (SOIT) and self-reported olfactory function; several social, cognitive, and medical risk factors at baseline; and incident dementia during the following decade. Results: Within the 10-year follow-up, 411 of 1,774 (23.2%) participants had died. In a Cox model, the association between higher SOIT score and lower mortality was significant (hazard ratio (HR) = 0.74 per point interval, 95% confidence interval (CI) = 0.71-0.77, P < .001). The effect was attenuated, but remained significant, after controlling for age, sex, education, and health-related and cognitive variables (HR = 0.92, 95% CI = 0.87-0.97, P = .001). The association between SOIT score and mortality was retained after controlling for dementia conversion before death (HR = 0.92, 95% CI = 0.87-0.97, P = .001). Similar results were obtained for self-reported olfactory dysfunction. Conclusion: Poor odor identification and poor self-reported olfactory function are associated with greater likelihood of future mortality. Dementia does not attenuate the association between olfactory loss and mortality, suggesting that olfactory loss might mark deteriorating health, irrespective of dementia.

  • 222.
    Emami, Habib
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Epidemiological studies on mental health in Tehran - Iran2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Since 1979 Iranians have experienced a variety of events that reasonably will have lasting effects on their mental health. In 1979 the Islamic Revolution took place and in 1980 eight years of Iraq-Iran war started. In recent years there has developed conflicts between Iran and the International society because of the Iranian activities in developing nuclear energy. To these can be added the social and religious limitations on the behavior of people. These limitations are experienced especially strong in the life of adolescents and young people. This thesis covers four different aspects of the mental health of Iranians. General health questionnaire (GHQ-12) was utilized to investigate the mental health of 4599 Iranian 3rd grade high school students (aged 17-18 years). The GHQ cut off was taken 7 or more. A considerable proportion of the students were at risk of suffering from mental health problems (29.5 %), girls more than boys. Periodic mental health surveys in high schools are proposed to identify students at risk and activities to improve their coping skills and problem-solving abilities. To study the methods of poisoning used for deliberate self harm, 2039 medical records in Loghman Hospital in Tehran were reviewed (52.3 % were females). Loghman Hospital is a specialized hospital for intoxication cases. In both genders the greatest proportions of individuals were in the ages 20-29. Drugs, pesticides and other agricultural chemicals were the most commonly used methods in each age group regardless of gender. Females outnumbered males especially in the youngest age group of 10 to 19 years of age.

    In a cross sectional study of 214 subjects from Tehran the Attitude Towards Suicide (ATTS) instrument was translated and validated in Farsi language. The coefficient alpha for all sections was more than 0.70 except for the Attitude section which was 0.68. Ten latent factors were extracted from the attitude section accounting for 61 % of the variance in the data. It is concluded that the instrument can be used to study suicide ideation and attempts in Iranian populations, but new items with special attention to Iranian cultural characteristics should be added to the attitude section. To make a cross cultural comparison of personality using the Temperament and Character Inventory (TCI) samples of 300 Germans, 300 Swedes and 316 Iranian subjects were studied. The factorial structural analysis using procrustes rotation method showed the structure of personality to be generally rather equivalent across cultures. It is apparent, however, that there are cultural differences between the Iranian and the European subjects mainly concerning character dimensions. These results support the theoretical assumptions that character development is mainly determined by socio-cultural factors during the socialization process. Based on our studies on independent samples in Iran a significant number of people are at risk of various mental health problems. A considerable number of young and adults are at risk of attempting self harm and suicide. Because of many limitations on specific topics of research in Iran including self harm and suicide we cannot present a realistic picture of this phenomenon in our society. There are different sources of tension in adolescent's life in Iran including familial and social sources. They are ever increasing in nature and in number. Besides these domestic sources of inconvenience our people is living in a kind of cold war situation which increases tension over life of all people.

  • 223.
    Emami, Habib
    et al.
    University of Social Welfare and Rehabilitation Sciences.
    Ghazinour, mehdi
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Rezaeishiraz, Hamed
    Department of Health Behavior, Rosewell Park Cancer Institute, Buffalo, New York.
    Richter, Jörg
    Centres of Child and Adolescent Mental Health, Regions East and South, Oslo, Norway.
    Mental health of adolescents in Tehran, Iran2007In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 41, no 6, p. 571-576Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate mental health in Iranian adolescents, particularly in high school students from urban areas. METHOD: A sample of 4599 girls and boys was selected from third year classes from high schools in Tehran by a stratified cluster random sampling method. They were investigated by means of the 12-item General Health Questionnaire (GHQ-12) in a cross-sectional study. Following the recommendations of Goldberg et al, the chosen cut-off point for the differentiation between individuals with and without psychiatric morbidity was a score of 7 because of the high mean score within the population. RESULTS: Of the students, 1270 (19.5%) achieved a GHQ-12 score above the threshold. Significantly more girls (34.1%) than boys (23.7%) had GHQ-12 scores indicating some psychiatric morbidity. On average, the 18-year-old adolescents reported a higher level of mental health problems compared with 17-year-old adolescents in the same school year. CONCLUSION: A considerable proportion of adolescent high school students experience mental disorders, with girls experiencing such disorders more frequently than boys. Periodic mental health surveys in high schools are proposed to identify students in need of counselling or treatment to improve their coping skills and problem-solving abilities.

  • 224. Engström, C
    et al.
    Thornlund, A S
    Johansson, E L
    Långström, M
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nylander, P O
    Anticipation in unipolar affective disorder.1995In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 35, no 1-2, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Anticipation describes an inheritance pattern within a pedigree with an increase in disease severity and/or decrease in age at onset in successive generations. The phenomenon of anticipation has recently been shown to be correlated with the expansion of trinucleotide repeat sequences in a neuromuscular disease, various neurodegenerative disorders and mental retardation. We have studied parent-offspring differences in age at onset and disease severity in 31 pairs with unilineal inheritance of unipolar affective disorder (UPAD). Life-table analyses showed a significant decrease in survival to 1st episode of major depression in the offspring generation compared with the parental generation (P = 0.0007). There was also a significant difference in age at onset (P < 0.001) between parents and offsprings. The offspring generation experienced onset 15.6 years earlier and illness 1.5 x more severe than did the parent generation. Furthermore, there was a significant correlation (P < 0.05) in age at onset between parent and offspring generations. When we excluded pairs where the affected parent has an age of onset greater than the age of the child at the time of ascertainment (i.e., 23 pairs left), there was still a significant (P = 0.02) decrease in age at onset (8.4 years) and 1.5 x more severe disease in the offspring generation. No evidence for specific maternal or paternal inheritance was found. We found evidence of anticipation in 75-80% of this sample of unilineal family pairs of UPAD. Anticipation is, thus, an inheritance pattern in a large group of UPAD which suggests that the expansion of trinucleotide repeat sequences is a possible mode of inheritance in this group of UPAD. The findings of anticipation in this study of families with UPAD and previous findings in families with BPAD suggest that the variable expression of unstable expansions of trinucleotide repeats may turn out to be the basis of the continuum of liability in affective disorders.

  • 225.
    Engström, Christer
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Åström, Monica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nordqvist-Karlsson, Barbro
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nylander, Per- Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Relationship between prophylactic effect of lithium therapy and family history of affective disorders.1997In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 42, no 6, p. 425-433Article in journal (Refereed)
    Abstract [en]

    Lithium therapy response and age of onset (AOO) were studied in 98 patients with bipolar affective disorder (BPAD) who were divided into subgroups depending on type of family history of affective disorders. The highest (33.0 years) and lowest (25.5 years) age of onset were found in nonfamilial patients and in familial patients with a first-degree relative of BPAD, respectively. Nonfamilial patients showed the best response to lithium. There were 0.9 episodes/year off lithium compared to 0.3 episodes/year on lithium (an 88% decrease). A poorer response (a 71% decrease; a reduction from 1.39 episodes per year off lithium to 0.65 on lithium) was found in familial patients with a first-degree relative of BPAD. Differences in serum lithium values between the groups could not explain the observed differences. Thus, familial patients showed a more severe manifestation of the disease with an earlier AOO and a lower prophylactic effect of lithium.

  • 226.
    Eriksson, I S
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Allard, P
    Umeå University, Faculty of Medicine, Department of Clinical Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Marcusson, J
    [3H]tiagabine binding to GABA uptake sites in human brain.1999In: Brain Research, ISSN 0006-8993, E-ISSN 1872-6240, Vol. 851, no 1-2, p. 183-8Article in journal (Refereed)
    Abstract [en]

    The binding of [3H]tiagabine ((RS-1-(4,4-(3-methyl-2-thienyl)-3-butenyl)-3-piperidine carboxylic acid) to homogenates of frozen post-mortem human brain has been characterized. Inhibition experiments with gamma-aminobutyric acid (GABA), GABA uptake inhibitors, ligands active at postsynaptic GABA receptors and receptors for other neurotransmitters, suggest that [3H]tiagabine binds with high affinity to GABA uptake sites. Inhibition and kinetic experiments suggests that 70%-80% of the binding is to a high affinity site. Saturation experiments showed that the binding was saturable. Bmax was 3.4 pmol/mg protein and Kd 16 nM in frontal cortex. The dissociation constants (Kd) measured in kinetic and equilibrium experiments were in the same range (16-56 nM). The regional distribution was studied in nine brain regions and the binding was heterogenous, with the highest binding in frontal cortex and parietal cortex and the lowest binding in nucleus caudatus and putamen. This is, to our knowledge, the first study on [3H]tiagabine binding in human tissue. It is concluded that [3H]tiagabine binding can be used as a specific marker for the GABA transporter GAT-1 in homogenates of human brain.

  • 227.
    Eriksson Sörman, Daniel
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Rönnlund, Michael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundström, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nilsson, Lars-Göran
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden .
    Social relationships and risk of dementia: a population-based study2015In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 27, no 8, p. 1391-1399Article in journal (Refereed)
    Abstract [en]

    Background: The objective was to examine whether aspects of social relationships in old age are associated with all-cause dementia and Alzheimer's disease (AD).

    Methods: We studied 1,715 older adults (≥ 65 years) who were dementia-free at baseline over a period of up to 16 years. Data on living status, contact/visit frequency, satisfaction with contact frequency, and having/not having a close friend were analyzed using Cox proportional hazards regressions with all-cause dementia or AD as the dependent variable. To control for reverse causality and to identify potential long-term effects, we additionally performed analyses with delayed entry.

    Results: We identified 373 incident cases of dementia (207 with AD) during follow-up. The variable visiting/visits from friends was associated with reduced risk of all-cause dementia. Further, a higher value on the relationships index (sum of all variables) was associated with reduced risk of all-cause dementia and AD. However, in analyses with delayed entry, restricted to participants with a survival time of three years or more, none of the social relationship variables was associated with all-cause dementia or AD.

    Conclusions: The results indicate that certain aspects of social relationships are associated with incident dementia or AD, but also that these associations may reflect reverse causality. Future studies aimed at identifying other factors of a person's social life that may have the potential to postpone dementia should consider the effects of reverse causality.

  • 228.
    Eriksson Sörman, Daniel
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundström, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Rönnlund, Michael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nilsson, Lars-Göran
    Department of Psychology, Stockholm University, Sweden .
    Leisure Activity in Old Age and Risk of Dementia: a 15-Year Prospective Study2014In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 69, no 4, p. 493-501Article in journal (Refereed)
    Abstract [en]

    Objectives. The aim of this study was to investigate whether leisure activity is associated with incident dementia in an older sample.

    Method. We examined a sample of 1,475 elderly (>= 65 years) who were dementia free at baseline over a follow-up period of up to 15 years. In addition to analyses involving the total time period, separate analyses of three time periods were performed, 1-5, 6-10, and 11-15 years, following baseline measurement of leisure activity.

    Results. After controlling for a variety of potential confounders, analyses of data for the total time period revealed that higher levels of "Total activity" and "Social activity," but not "Mental activity," were associated with decreased risk of dementia. However, analyses of the separate time periods showed that this association was only significant in the first time period, 1-5 years after baseline.

    Discussion. The results from this study provide little support for the hypothesis that frequent engagement in leisure activities among elderly serve to protect against dementia diseases across a longer time frame. The finding of a relationship for the first time period, 1-5 years after baseline, could indicate short-term protective effects but could also reflect reverse causality.

  • 229.
    Fekadu, Abebaw
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Studies on affective disorders in rural Ethiopia2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Affective disorders are poorly defined and studied in sub-Saharan Africa despite their substantial public health impact.

    Objectives

    Overall objective: To describe the epidemiology of selected affective disorders in rural Ethiopia.

    Specific objectives

    1. To describe the validity and utility of the concept of minor depressive disorder (mD).

    2. To describe the manifestation, prevalence and the short-term clinical and functional course and outcome of bipolar disorder.

    Subjects and methods

    Population: Zay community residents (age ≥16), and residents of Butajira (ages 15-49), in Southern Ethiopia.

    Study design: Population-based cross-sectional and longitudinal studies

    Case identification: For the identification of cases with bipolar disorder, a two stage process was employed. An initial screen used key informants and interview with the Composite International Diagnostic Interview (CIDI) to identify cases with probable bipolar disorder. A second confirmatory diagnostic assessment stage employed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). For the identification of cases with mD, data from the CIDI was used.

    Follow-up: 312 cases with bipolar disorder from Butajira were followed up for a mean of 2.5 years (ranging 1-4 years) through monthly clinical assessments and annual symptom and functional ratings.

    Results

    The CIDI was administered to 1714 adults among the Zay and to 68, 378 adults among the Butajira residents. The prevalence of mD among the Zay and Butajira was 20.5% and 2.2% respectively. Up to 80% of cases with mD had used services for their symptoms, while a third to a half of cases had thought about self harm. Up to a sixth of cases had attempted suicide. Age, marital status, education and somatic symptoms were independently associated with mD.

    The prevalence of bipolar disorder among the Zay was 1.8%. During a 2.5-year follow-up of 312 cases with bipolar disorder from Butajira, 65.9% relapsed (47.8% manic, 44.3% depressive and 7.7% mixed episodes) while 31.1% experienced persistent illness. Female gender predicted depressive relapse whereas male gender predicted manic relapse. Only being on psychotropic medication predicted remission (OR=3.42; 95% CI=1.82, 6.45). Disability was much worse among bipolar patients than in the general population and was predicted by symptom se3verity.

    Conclusions

    This is the largest study on mD and bipolar disorder in Africa. mD appears to have potential clinical utility in this setting given its association with service use and risk. The identified risk factors for mD also suggest potential aetiological continuity with major depression. The relatively high prevalence of bipolar disorder among the Zay may be related to genetic predisposition perhaps mediated through a founder effect, but other factors need exploring. In relation to the outcome of bipolar disorder, this study indicates that, contrary to previous assumptions, the course of bipolar disorder is characterised by both manic and depressive relapses in a relatively proportionate fashion. Bipolar disorder also leads to significant levels of disability. This is the only prospective outcome study of bipolar disorder in Africa where cases were monitored systematically at short assessment intervals. Therefore, findings are likely to be more robust than previous reports.

  • 230.
    Fekadu, Abebaw
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Medhin, Girmay
    Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
    Shibre, Teshome
    Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
    Cleare, Anthony
    King's College London, Institute of Psychiatry, London, UK.
    Prince, Martin
    King's College London, Institute of Psychiatry, London, UK.
    Kebede, Derege
    World Health Organization, Regional Office for Africa, Brazzaville, Congo.
    Utility of the concept of minor depressive disorder: evidence from a large rural community sample in a developing country setting2007In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 104, no 1-3, p. 111-118Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence on the utility of the minor depressive disorder diagnostic construct in rural communities and developing countries is scarce. AIM: To assess the utility and validity of definitive minor depressive disorder in Ethiopia by determining its impact and sociodemographic correlates.

    METHODS: Assessment of 68,378 adults, aged 15-49 years, living in a largely rural district in Ethiopia using the Composite International Diagnostic Interview.

    RESULTS: The lifetime prevalence of minor depressive disorder was 2.2% (95% CI=2.1%, 2.3%). Age, marital status, education and unemployment independently predicted minor depressive disorder. Over 80% of cases used health services, 55.1% experienced persistent thoughts of death and 14.6% attempted suicide.

    LIMITATION: Findings are based on lifetime estimates.

    CONCLUSIONS: Minor depressive disorder is an important public health problem in rural Ethiopia, as shown by the associated high health service use and risk behaviour. Sociodemographic correlates suggest aetiological continuity with major depression. Thus our findings extend the clinical and public health utility of this diagnostic construct to rural community and developing country settings.

  • 231.
    Fekadu, Abebaw
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    O'Donovan, Michael C
    Department of Psychological Medicine, School of Medicine, Cardiff University, Cardiff, UK.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebede, Derege
    Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
    Church, Steve
    Maudsley Hospital, South London and Maudsley NHS Trust, London, UK.
    Johns, Louise
    Section of Epidemiology, Health Services Research Department, Institute of Psychiatry, King’s College London, UK.
    Medhin, Girmay
    Department of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
    Prince, Martin
    Section of Epidemiology, Health Services Research Department, Institute of Psychiatry, King’s College London, UK.
    Shibre, Teshome
    Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
    Validity of the concept of minor depression in a developing country setting2008In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 196, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Evidence for validity of the diagnostic construct of minor depressive disorder comes primarily from reports on subthreshold depressive states rather than minor depressive disorder per se. We report on the prevalence, impact, and sociodemographic correlates of minor depressive disorder in a developing country setting as further validation of this diagnostic construct. Diagnostic assessment of 1714 adults of an island population in Ethiopia was carried out using the Composite International Diagnostic Interview. The lifetime prevalence of minor depressive disorder was 20.5% (95% confidence interval 18.6, 22.5%). One-third of cases had sought help and expressed suicidal ideation. Being divorced/widowed, middle-aged, and having somatic pain were independently associated with having minor depressive disorder. Only being divorced/widowed was a shared risk factor for both minor depressive disorder and bereavement. Minor depressive disorder seems to be a useful and valid diagnostic construct with particular clinical significance in this and, possibly, similar developing country settings.

  • 232.
    Fekadu, Abebaw
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shibre, Teshome
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebede, Derge
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Kebreab, Samuel
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Negash, Alemayehu
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Owen, Michael J
    Department of Psychological Medicine, University of Wales College Medicine, Cardiff, UK.
    Bipolar disorder among an isolated island community in Ethiopia2004In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 80, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychiatric data on population groups of geographic and social isolates are rare, but can potentially give insights into factors of aetiological importance. The Zeway islanders have lived in geographic and cultural isolation for over three centuries.

    AIM: To determine the prevalence of major psychiatric disorders among the adult population of Zeway islands.

    METHODS: A three stage screening design that included the use of structured interview instruments (CIDI and SCAN), key informants, and clinical assessment by psychiatrists was employed for case identification.

    RESULTS: Prevalence of bipolar disorders among the adult population (n = 1691) was 1.83% (n = 31) with 66% of the cases originating from one of the islands that constitutes only 17.33% of the study population. Only one subject was identified with schizophrenia.

    CONCLUSIONS: A pattern of differential prevalence for bipolar disorders and schizophrenia appears to exist in this isolated population, which also seems shared by other isolated population groups. The high prevalence of bipolar disorders with clustering of cases on one island may represent an environmental or genetic factor of etiologic relevance that deserves further exploration.

  • 233.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Child labour and emotional disorders in an urban district, Ethiopia: a rapid assessment on community perception of child labour2001In: Ethiopian journal of health development, ISSN 1021-6790, Vol. 15, no 3, p. 197-202Article in journal (Refereed)
  • 234.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child abuse in child labor in urban district, EthiopiaManuscript (preprint) (Other academic)
  • 235.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    The prevalence of mental health problems in Ethiopian child laborers.2006In: Journal of child psychology and psychiatry, ISSN 0021-9630, Vol. 47, no 9, p. 954-959Article in journal (Refereed)
  • 236.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Review of child labor with emphasis on mental healthManuscript (Other academic)
  • 237.
    Fernandes, Carla Patricia Duarte
    et al.
    K.G. Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
    Westlye, Lars Tjelta
    K.G. Jebsen Centre for Psychosis Research, Norwegian Centre For Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, Department of Psychology, University of Oslo, Oslo N-0317, Norway.
    Giddaluru, Sudheer
    K.G. Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
    Christoforou, Andrea
    K.G. Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
    Kauppi, Karolina
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nilsson, Lars-Göran
    Department of Psychology, Stockholm University and Stockholm Brain Institute, Uppsala, Sweden.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Lundervold, Astri Johansen
    Department of Biological and Medical Psychology, K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway, Kavli Research Centre for Aging and Dementia, Haraldsplass Deaconess Hospital.
    Reinvang, Ivar
    Department of Psychology, University of Oslo, Oslo N-0317, Norway.
    Steen, Vidar Martin
    K.G. Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
    Le Hellard, Stéphanie
    K.G. Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
    Espeseth, Thomas
    K.G. Jebsen Centre for Psychosis Research, Norwegian Centre For Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, Department of Psychology, University of Oslo, Oslo N-0317, Norway.
    Lack of association of the rs1344706 ZNF804A variant with cognitive functions and DTI indices of white matter microstructure in two independent healthy populations2014In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 222, no 1-2, p. 60-66Article in journal (Refereed)
    Abstract [en]

    The rs1344706 single nucleotide polymorphism within intron 2 of the ZNF804A gene is strongly associated with schizophrenia and bipolar disorder. This variant has also been associated in some studies with a range of cognitive and neuroimaging phenotypes, but several studies have reported no effect on the same phenotypes in other samples. Here, we genotyped 670 healthy adult Norwegian subjects and 1753 healthy adult Swedish subjects for rs1344706, and tested for associations with cognitive phenotypes including general intellectual abilities, memory functions and cognitive inhibition. We also tested whether rs1344706 is associated with white matter microstructural properties using diffusion tensor imaging (DTI) data from 250 to 340 of the Norwegian and Swedish subjects, respectively. Whole-brain voxel-wise statistical modeling of the effect of the ZNF804A variant on two DTI indices, fractional anisotropy (FA) and radial diffusivity (RD), was performed using tract-based spatial statistics (TBSS), and commonly reported effect sizes were calculated within several large-scale white matter pathways based on neuroanatomical atlases. No significant associations were found between rs1344706 and the cognitive traits or white matter microstructure. We conclude that the rs1344706 SNP has no significant effect on these phenotypes in our two reasonably powered samples.

  • 238.
    Figueira, Joao
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nordin Adolfsson, Annelie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Öhman, Anders
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Serum Metabolite Markers of Dementia Through Quantitative NMR Analysis: The Importance of Threonine-Linked Metabolic Pathways2019In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 69, no 3, p. 763-774Article in journal (Refereed)
    Abstract [en]

    There is a great need for diagnostic biomarkers of impending dementia. Metabolite markers in blood have been investigated in several studies, but inconclusive findings encourage further investigation, particularly in the pre-diagnostic phase. In the present study, the serum metabolomes of 110 dementia or pre-diagnostic dementia individuals and 201 healthy individuals matched for age, gender, and education were analyzed by nuclear magnetic resonance spectroscopy in combination with multivariate data analysis. 58 metabolites were quantified in each of the 311 samples. Individuals with dementia were discriminated from controls using a panel of seven metabolites, while the pre-diagnostic dementia subjects were distinguished from controls using a separate set of seven metabolites, where threonine was a common significant metabolite in both panels. Metabolite and pathway alterations specific for dementia and pre-diagnostic dementia were identified, in particular a disturbed threonine catabolism at the pre-diagnostic stage that extends to several threonine-linked pathways at the dementia stage.

  • 239.
    Figueira, Joao
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Jonsson, Pär
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Nordin Adolfsson, Annelie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Öhman, Anders
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    NMR analysis of the human saliva metabolome distinguishes dementia patients from matched controls2016In: Molecular Biosystems, ISSN 1742-206X, E-ISSN 1742-2051, Vol. 12, no 8, p. 2562-2571Article in journal (Refereed)
    Abstract [en]

    Saliva is a biofluid that is sensitive to metabolic changes and is straightforward to collect in a non-invasive manner, but it is seldom used for metabolite analysis when studying neurodegenerative disorders. We present a procedure for both an untargeted and targeted analysis of the saliva metabolome in which nuclear magnetic resonance (NMR) spectroscopy is used in combination with multivariate data analysis. The applicability of this approach is demonstrated on saliva samples selected from the 25 year prospective Betula study, including samples from dementia subjects with either Alzheimer's disease (AD) or vascular dementia at the time of sampling or who developed it by the next sampling/assessment occasion five years later, and age-, gender-, and education-matched control individuals without dementia. Statistically significant multivariate models were obtained that separated patients with dementia from controls and revealed seven discriminatory metabolites. Dementia patients showed significantly increased concentrations of acetic acid (fold change (fc) = 1.25, p = 2 x 10(-5)), histamine (fc = 1.26, p = 0.019), and propionate (fc = 1.35, p = 0.002), while significantly decreased levels were observed for dimethyl sulfone (fc = 0.81, p = 0.005), glycerol (fc = 0.79, p = 0.04), taurine (fc = 0.70, p = 0.007), and succinate (fc = 0.62, p = 0.008). Histamine, succinate, and taurine are known to be important in AD, and acetic acid and glycerol are involved in related pathways. Dimethyl sulfone and propionate originate from the diet and bacterial flora and might reflect poorer periodontal status in the dementia patients. For these seven metabolites, a weak but statistically significant pre-diagnostic value was observed. Taken together, we present a robust and general NMR analysis approach for studying the saliva metabolome that has potential use for screening and early detection of dementia.

  • 240.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Zingmark, Karin
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions2016In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 28, no 4, p. 321-338Article in journal (Refereed)
    Abstract [en]

    Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved.

  • 241.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Towards a method for clinical ethics support to promote inter-professional communication about ethically difficult care situations: observations of an interventionManuscript (preprint) (Other academic)
    Abstract [en]

    Background Studies show that healthcare professionals need inter-professional clinical ethics support (CES) to communicate and reflect on ethically difficult care situations. Internationally, various CES-interventions have been performed, but the communication process and the organisation of CES are sparsely described in the literature. The CES intervention observed in this study was inspired by Habermas’ theory of communicative action and involved healthcare professionals meeting inter-professionally to discuss value conflicts to achieve a common understanding and arrive in agreement about how to act and relate. The communication of value conflicts during a series of sessions in this CES - intervention has been described in a previous study. To further develop a clearly described theory-based CES-method it is important to increase knowledge about the conditions that can promote communication of value conflicts. The aim of this study was therefore to explore the organisational and communicative conditions of a CES intervention with the intention to promote interprofessional communication about ethically difficult care situations.

    Methods Eight audio- and video-recorded CES sessions were conducted over a period of eight months. The observations were transcribed and sorted by using the video analysis tool Transana and analyzed with concept and data-driven content analysis methods.

    Results The findings show the CES organization as an integrated framework, providing both a given structure and openness for variation, as conditions for facilitating the communication of value conflicts. The structure consisted of both constancy and flexibility. The given structure provided constancy while the openness for variation provided flexibility. The combination of constancy and flexibility generated bot safety, and stability for a free and dynamic dialogue, and opened up for responsiveness and creativity to find proposals for actions. As courses of actions to reach communicative agreement were the approaches of a permissive communication, extended views and mutual understanding found.

    Conclusion The results showed CES as an integrated framework with a given structure and openness for variations as conditions to reach a communicative agreement. The findings constitute a step towards a clearly described CES method based on Habermas theory of communicative action. Extended intervention studies with different kinds of data needs to be conducted in order to fully develop the method and get increased knowledge about how to promote a dialogue about ethically difficulties.

  • 242.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Zingmark, Karin
    Communicative and organizational aspects of clinical ethics support.2018In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

  • 243.
    Fischer Grönlund, Catarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Zingmark, Karin
    County Council of BD, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahlqvist, Vera
    Ethically difficult situations in hemodialysis care: nurses' narratives2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 6, p. 711-722Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.

    RESEARCH QUESTION: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.

    RESEARCH DESIGN: This study has a phenomenological hermeneutic approach.

    PARTICIPANTS: Narrative interviews were carried out with 10 registered nurses working in dialysis care.

    ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.

    RESULTS: One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.

    DISCUSSION: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.

    CONCLUSION: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

  • 244.
    Fjellfeldt, Maria
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eklund, Mona
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Implementation of choice from participants' perspectives: a study of community mental healthcare reform in Sweden2016In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 15, no 2, p. 116-133Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore participants' experiences and opinions about a free-choice system in relation to policy objectives articulated by the national government and local authorities. A case study was conducted. Thirty-five informants participated. Qualitative interviews were undertaken. Results are discussed on how to address different dimensions of choice, not only where, but also what, by whom, how much, and when. They also concern how to design systems that in some ways ensure predictability and continuity to avoid unwanted harm caused by the unpredictability embedded in competitive choice systems. Finally, different aspects of quality need to be addressed.

  • 245. Forero, Diego A.
    et al.
    Herteleer, Liesbet
    De Zutter, Sonia
    Norrback, Karl-Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Hospital, Sweden.
    Nilsson, Lars-Göran
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Hospital, Sweden.
    Callaerts, Patrick
    Del-Favero, Jurgen
    A network of synaptic genes associated with schizophrenia and bipolar disorder2016In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 17, no 1-3, p. 68-74Article in journal (Refereed)
    Abstract [en]

    Identification of novel candidate genes for schizophrenia (SZ) and bipolar disorder (BP), two psychiatric disorders with large epidemiological impacts, is a key research area in neurosciences and psychiatric genetics. Previous evidence from genome-wide studies suggests an important role for genes involved in synaptic plasticity in the risk for SZ and BP. We used a convergent genomics approach, combining different lines of biological evidence, to identify genes involved in the cAMP/PKA/CREB functional pathway that could be novel candidates for BP and SZ: CREB1, CREM, GRIN2C, NPY2R, NF1, PPP3CB and PRKAR1A. These 7 genes were analyzed in a HapMap based association study comprising 48 common SNPs in 486 SZ, 351 BP patients and 514 control individuals recruited from an isolated population in Northern Sweden. Genetic analysis showed significant allelic associations of SNPs in PRKAR1A with SZ and of PPP3CB and PRKAR1A with BP. Our results highlight the feasibility and the importance of convergent genomic data analysis for the identification of candidate genes and our data provide support for the role of common inherited variants in synaptic genes and their involvement in the etiology of BP and SZ.

  • 246.
    Forsberg, Karl A
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11-12, p. 1519-1528Article in journal (Refereed)
    Abstract [en]

    Improving physical health with lifestyle programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

  • 247.
    Forsberg, Karl Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. The Vårdal Institute, the Swedish Institute for Health Sciences, Lund.
    Björkman, Tommy
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Influence of a life style intervention among persons with a psychiatric disability: a cluster randomised controlled trial on symptoms, quality of life and sense of coherence2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11-12, p. 1519-1528Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim of this study was to investigate how a life style intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities.

     Background: Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at life style interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities.

    Design: a cluster randomised controlled trail.

    Methods: Forty one persons with a DSM- ІV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12 month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance.

    Results: A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up.

    Conclusions: Structured activities in the form of life style intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence.

    Relevance to clinical practice: Improving physical health with life style programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

  • 248.
    Forsberg, Karl Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Physical health: a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 6, p. 486-495Article in journal (Refereed)
    Abstract [en]

    The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities, and their caregivers. Their satisfaction with the intervention was also assessed. Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known. Few randomized controlled trials have been aimed specifically at lifestyle issues among persons with a psychiatric disability. This trial includes clients with psychiatric disabilities living in supported housing and their staff. Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005-2006 in Sweden. The supported housing facilities with residents and staff were randomly assigned to either a health intervention programme or a control programme with an aesthetic content. The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c, P-glucose, P-insulin, lipids, blood pressure, physical working capacity, body mass index, Heart Score were investigated and participants' satisfaction assessed. There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up. The participants expressed satisfaction with the programme. The results indicate that health interventions on lifestyle issues when involving carers are appreciated, feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities.

  • 249. Forsberg, Karl-Anton
    et al.
    Johansson, M
    Åhman, K
    Borgstedt, M
    Karlsson, EC
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hälsa och ett liv i balans för personer med psykisk funktionsnedsättning: en arbetsbok för dig som coachar2012 (ed. 1)Book (Refereed)
  • 250.
    Forsberg, Karl-Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy Nils
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meanings of participating in a lifestyle programme for persons with psychiatric disabilities.2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 357-364Article in journal (Refereed)
    Abstract [en]

    Lifestyle changes that affect physical and psychological health are described in research literature; however, the meaning of participating in a lifestyle intervention programme together with the staff has not been described. This study illuminates meanings of participating in a lifestyle programme as experienced by persons with psychiatric disabilities. The first author interviewed five women and six men with schizophrenia and depressive syndrome, aged 26-53, participating in a lifestyle programme. The transcribed interviews were analysed using a phenomenological hermeneutic approach inspired by the philosophy of Ricoeur. Meanings of participating in a lifestyle programme include my health can be improved as both the physical effects and the obstacles are considered and the daily life is partially given a changed content in new experiences and by participating in something to take pride in. The meanings of participating together with the staff mean an increased sense of closeness and equality with the staff expressed in changes in relationships and the difference between the two groups being revealed and also in becoming aware of the life situation, an insight into the loss of a healthy life but also hope for the future is expressed. The conclusions that could be drawn from this study are that a lifestyle intervention affects health and other important life areas such as the content of daily life and the relationship with the carers, which appears to affect the sense of hope and the ability to see new possibilities. Carers should find situations and activities where the residents and carers participate under equal conditions giving the residents the opportunity to leave the sick roll, experience equality and develop good relationships.

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